I, the undersigned, consent to the optometric services to be provided by the healthcare professionals at KCS. These services may include:
- Comprehensive eye examination
- Prescription of corrective lenses (glasses or contact lenses)
- Screening and management of eye diseases such as glaucoma, cataracts, and diabetic retinopathy
- Dilation of pupils for better examination of the internal structures of the eyes
- Referrals to ophthalmologists or other specialists if necessary
Disclosure of Risks and Benefits
I understand that certain procedures, such as dilation or the use of eye drops, may cause temporary discomfort, blurred vision, or light sensitivity. The risks and benefits of these procedures have been explained to me, and I will have the opportunity to ask questions.
Privacy and Confidentiality
I acknowledge that my personal and medical information will be kept confidential in accordance with HIPAA regulations and will only be shared with necessary healthcare professionals for the purposes of my treatment, billing, or healthcare operations.
Patient Rights
I understand that I have the right to:
- Be informed about my diagnosis, treatment options, and any potential risks
- Refuse or withdraw consent for treatment at any time
- Receive a second opinion if desired